OBJECTIVES: To assess the cost-effectiveness of Abiraterone Acetate plus Prednisone (A-P) compared with Cabazitaxel plus Prednisone (C-P) in Panama, in patients with Metastatic Castration-Resistant Prostate Cancer (mCRPC) that have failed to chemotherapy with Docetaxel. METHODS: A three-health state cohort simulation Markov Model (progression-free, post-progression and death) was developed based on overall and progression free survival data. The time frame was 10 years. The perspective was that of the Public System of Health of Panama. The health outcomes of interest were Quality Adjusted Life Years (QALYs) and Life Years (LYs). Efficacy data was taken from clinical trials (COU-AA-301 for A-P and TROPIC for C-P). Utilities for health states and negative utilities for adverse events were estimated based on quality of life endpoints of the COU-AA-301 trial. The base year was 2012. All costs are presented in United States Dollars (USD). Costs and outcomes were discounted at 5%. Probabilistic sensitivity (PSA) analysis was performed to evaluate uncertainty surrounding the parameters. RESULTS: A-P resulted in 0.79 QALYs and 1.35 LYs, per patient, respectively. C-P resulted in 0.71 QALYs and 1.28 LYs, per patient, respectively. Mean total costs per patient were:  USD 76.179 for A-P and USD 86.286 for C-P. The results of the probabilistic sensitivity analysis showed that, when compared with C-Z, A-P was found dominant (associated with reduced costs and increased QALYs) in the majority of the iterations. A-P had a 73% probability of being cost effective, independent of the willingness to pay, when compared to C-P. When the willingness to pay increases, A-P is more likely to become cost effective. CONCLUSIONS: A-P can be considered dominant (cost-saving), when compared with C-P, in patients with Metastatic Castration-Resistant Prostate Cancer that have failed to chemotherapy with Docetaxel, from the perspective of the Public System of Health of Panama.